Notebook Page 27 Summer Update

The Legislature is finally home for the summer leaving the Michigan ACS CAN team preparing for their return in September. Activities this summer have focused on access to oral chemotherapy, but we did take a moment to celebrate some big wins in the access to healthy food space.

In June the Legislature finished its budget work. ACS CAN along with other partners were working on three issues that were in the Health and Human Services and the K-12 School Aid budget. This year’s budget included additional funding for farmer's markets. The new funding changes Michigan's contract to allow wireless credit card devices to accept SNAP payments and funding to purchase those wireless devices.  The contract only included the use of wired devices making the cost of wireless devices an obstacle for farmer’s markets to take SNAP benefits.  Many farmers don’t have the means to purchase expensive wireless devices; this funding will help remove that obstacle.

Additional funding for the 10 Cents a Meal program will be including in this year’s budget. The 10 Cents a Meal program is currently in northern Michigan and is providing schools 10 extra cents per child per meal to purchase fresh produce from local growers. The program only had funding for 16 schools to participate out of the 52 schools that applied.  Local farmers have the fresh fruits and vegetables that students need but are challenged to get it into the school systems. These additional funds will be used to continue and expand the pilot program into Washtenaw County to help schools get these fresh fruits and vegetables while helping local growers in the process. 

We were not able to secure funds for our corner store initiative.  This initiative would have provided a one-time grant to corner stores and convenience stores to put in equipment that would make it easier to sell fresh fruits and vegetables in their stores.  These stores would be focused on areas in the state that do not have access to fresh fruits and vegetables and these stores are the only place that people

can get groceries. It is our plan to obtain this funding in the coming month.

We are now shifting our focus to oral chemotherapy fairness. Senator Goeff Hansen, our sponsor last year, submitted another bill for this session. His oral chemotherapy legislation is Senate Bill 492, which in its current form we do not support. This time around there is an opt out section in the legislation that would allow health plans to opt out of providing coverage raises their premiums by 1%. The last session when we offered this type of amendment it was in a way that used true data from the health insurers, this time around it allows the insurance companies to forecast their potential impact of providing parity and if their forecast says it would raise premiums by 1% then they could opt out. Since the numbers will be fictional we are opposed to using any data that is not gathered from experience.

All of these developments, we put into place a postcard program that allows those wanted to share their support for oral chemotherapy fairness to send it to their representative or senator voicing their support. This is to show that efforts need to be taken to provide fairness and they need to be done in the right way.  If you are interested in obtaining some postcards please contact Matt at matt.phelan@cancer.org. 

Senate Fails to Replace Health Care Law
In the early morning hours of July 28, the U.S. Senate fell short of the votes needed to pass legislation that would have repealed parts of the current health care law. Had the legislation passed, it would have likely resulted in millions losing health insurance and patients paying more for less coverage.

The Senate vote came nearly three months after the House approved the American Health Care Act (AHCA) – legislation that would have replaced the current health care law.
Our grassroots engagement and media advocacy efforts were extraordinary and played a remarkable role in shaping the public debate. Our opposition was noted the time and again in the media and by legislators. We elevated the patient voice through volunteer mobilization, media advocacy, social media campaigns, direct lobbying and coalition work, targeting House and Senate members from 15 key states. Our  “Keep Us Covered” Campaign placed the voice of cancer patients, survivors and their families front and center in the debate.

ACS CAN patient volunteers from 14 of the 15 target states traveled to Washington, DC in late June to make lawmakers aware of the opposition by patient communities to the Senate’s Better Care Reconciliation Act (BCRA). The ACS CAN-led patient fly-in was held in coordination with 12 other organizations including the American Diabetes Association, the American Heart Association, the American Lung Association, Consumers Union and the Cystic Fibrosis Foundation. The groups collectively flew in over 60 patients from all 15 target states. Senators from the target states were expected to play a major role in deciding if the bill moved forward. The patients participated in an ACS CAN-led training, and over 100 advocates, including patients and staff from participating organizations, were in attendance. In meetings with lawmakers, patient stories were particularly effective at providing the cancer perspective and illustrating how insurance market reforms in the current law provide greater access to preventative screenings and quality comprehensive health insurance coverage.

Prior to scheduled calls between a select group of governors and Senate leadership, ACS CAN sent a letter to governors of both parties across the country detailing our concerns about proposals that would result in dramatically reducing Medicaid funding; reintroducing discrimination based on health history; waiving minimum essential benefits requirements; eliminating steady funding streams that subsidize affordable health insurance coverage; and instituting continuous coverage requirements that could discriminate against those who cannot work due to illness or who have to take leave to care for a loved one.

ACS CAN has regularly noted that the current law has weaknesses and needs improvement. During the House and Senate debate, we tried to work with lawmakers to identify ways to make the law work better for cancer patients – as did the American Medical Association, other patient groups, hospitals, and insurers.

ACS CAN’s goal from the beginning has been to urge lawmakers on both sides of the aisle to fix the portions of the current law that are not functioning properly so that it is strengthened and improved in ways that reduce the national cancer burden. We have intentionally positioned ourselves as a resource to help federal legislators do just that. As part of that positioning, our staff and volunteers executed a deliberate campaign to educate lawmakers on the adverse impact certain aspects of the proposed legislation would have had on those with a history of cancer or those that are at risk.
A few metrics:

• 128,000 total petition signatures, action pledges and messages sent to Congress
• Nearly 20,000 new volunteers have joined ACS CAN through the campaign
• #KeepUsCovered hashtag used over 16,000 times and reached 42 million people on social media
• More than 30,000 calls in to Capitol Hill offices since February
• More than 720 national and regional clips (with numerous placements in 15 target states) since January 1, including The Washington Post, USA Today, Bloomberg News, NPR, the Los Angeles Times and cable news networks like MSNBC
• A national and regional advertising campaign that was highlighted in The New York Times 

ACS CAN continues to call on lawmakers to work together and we stand ready to assist Congress in developing practical, bipartisan solutions that ensure any future health care proposal meets the needs of cancer patients, survivors, and their families.

Federal Research Funding Cuts Proposed
The President’s budget, released March 16, proposed funding changes for the remainder of the current fiscal year (FY17) and funding levels for next year (FY18). The federal government is the nation’s largest single funder of cancer research and prevention. The budget submitted to Congress would:

• cut funding of the National Institutes of Health (NIH) by $1.2 billion (FY17);
• scale back programs at the Centers for Disease Control and Prevention (CDC), including funding for state cancer registries and tobacco control, by $65 million this year (FY17);
• reduce funding to the NIH by an additional $7.2 billion next year (FY18), including an estimated $1.2 billion cut to the National Cancer Institute (NCI); and
• cut CDC funding for cancer prevention and other chronic disease programs and consolidate the programs into block grants for states (FY18).

The proposed cut to the NIH budget for next year would constitute the largest reduction in medical research funding in history. If enacted, these cuts would also wipe out funding for the Cancer Moonshot initiative approved by Congress late last year with the strong bipartisan support and the enabled funding in the 21st Century Cures Act. It would, in effect, set the NIH back nearly 20 years and prove disastrous. 

House Slashes Funding for CDC’s Office on Smoking and Health 
On July 19, the House Appropriations Committee passed its fiscal year 2018 funding bill which includes the CDC. The bill slashed funding for Office on Smoking and Health (OSH) by nearly 25 percent from $205 million to $155 million. This cut would significantly undercut the OSH efforts to prevent kids from using tobacco products and help smokers quit.

One program that is funded by OSH and would likely end, is the highly visible and tremendously successful effort called Tips from Former Smokers campaign, the first ever paid national tobacco public education campaign. It was launched in 2012 with paid advertisements of real smokers telling their stories of the consequences they have experienced because of smoking or exposure to secondhand smoke. The TV, print, radio, and internet ads focused on cancer, heart disease, stroke, preterm birth, and diabetes, among other health effects of smoking. In the first three years, the campaign has helped 5 million smokers make a quit attempt, 300,000 smokers quit for good, and saved at least 50,000 lives.

ACS CAN will be working to ensure that when the Senate considers its version of the bill this fall, it does not significantly cut OSH.

Congress Works to Undercut FDA Authority over Certain Tobacco Products 
On July 13, the House Appropriations Committee passed a bill which would fund the U.S. Food and Drug Administration (FDA) for fiscal year 2018. Two of the bill’s provisions would significantly undercut FDA oversight of e-cigarettes and many cigars currently on the market and completely exempt some cigars from FDA oversight authority.

One week later, the Senate Appropriations Committee passed its version of the bill which leaves the FDA’s tobacco products oversight authority intact. ACS CAN continues work to ensure that the Senate committee version of the FDA funding prevails in the negotiation of a final bill.

FDA Delays Implementation of Final Guidance on Tobacco Deeming
Congress granted the Food and Drug Administration (FDA) authority over tobacco products in the Family Smoking Prevention and Tobacco Control Act in 2009. Using this authority in 2016, FDA regulated cigars and e-cigarettes in the “deeming rule,” which prompted numerous lawsuits. The previous administration defended the rule in the first lawsuit, but the current administration asked for time extensions in two related cases so that it could review its position.

In May, FDA announced it will defer enforcement of all future compliance deadlines for all deeming rule products for three months.

ACS CAN and other public health groups filed an amicus brief in the first case, Nicopure Labs v. FDA. On July 25, a federal court upheld the deeming rule in its entirety.

However, concerned that the government may decide not to defend the rule in other pending cases, ACS CAN and public health partners petitioned the courts on July 24 seeking intervenor status in the two related lawsuits. If intervenor status is granted, the public health groups become parties to the cases and participate in all phases of the litigation.

ACS CAN Responds to Nutrition Labeling Delays
Despite becoming law in 2010 as part of the Affordable Care Act, the FDA has yet to implement the law requiring menu labeling of calories for restaurants and other food service establishments. The regulations to implement the law were set to go into effect in early May but the administration delayed the implementation until May 7, 2018, and opened the implementing regulation to potential modification at the behest of supermarkets, convenience store associations and the pizza industry. ACS CAN submitted comments on the regulation, opposing the delay in implementation and any changes to the menu labeling requirements to make the information less useful in informing healthy choices.

Meanwhile, on July 27 the House Energy and Commerce Committee passed the Common Sense Nutrition Disclosure Act of 2017, which would make changes to the menu labeling requirements that could make it more difficult for consumers to access and use calorie information in their food and beverage purchase decisions. The bill now awaits consideration on the floor of the House of Representatives. A companion bill is in the Senate.


ACS CAN will continue to work to secure implementation of the current law and in opposition to passage of the House and Senate bills which would undercut the current law and the availability of calorie information which would be beneficial to consumers.

Notebook Page 26 May/June 2017

Michigan is starting to wind down its budget work for the year with the federal government starting to talk about the budget, research funding, and others. Here's a breakdown of activity on both fronts for May and June.

Federal Update

American Health Care Act

On May 4, following months of negotiation between U.S. House leaders and the President, the U.S. House approved the American Health Care Act (AHCA) that would partially repeal and replace the current health care law.

The impact of the AHCA bill has been widely understood since the Congressional Budget Office (CBO) issued its updated assessment of the House-passed American Health Care Act (AHCA) – estimating the number of Americans who would likely lose health insurance as compared to current law, as well as the possible cost changes for those who maintain coverage.

The CBO projects that under the House-approved legislation the number of uninsured will increase by 14 million next year, 19 million in 2020 and, 23 million by 2026.  Low and moderate income seniors between the ages of 50-65 will experience significant premium increases due to changes in age rating.  Millions of lower-income Americans will be stripped of their Medicaid coverage.

Additionally, we do know that this legislation would allow states to opt out of insurance market rules in the current law that protect patients with pre-existing conditions from higher costs, and would allow insurers to offer plans that may not provide coverage for cancer screenings and treatments.  These requirements, which are in the current law, will become optional in certain states if the AHCA were to become law.

Essentially the AHCA would allow states to make these changes if they create a special high-risk pool to segment high-risk patients, such as those who have cancer, out of the private market insurance pool. The idea is to lower premiums for healthy people while placing sicker patients in the high-risk pool. The problem with such a solution, as we have pointed out numerous times to our elected representatives, is that high-risk pools were a failure when they were used prior to passage of the current law because they were never adequately funded.  And despite the assertions of AHCA’s supporters, high-risk pools are not adequately supported in this bill.  Very few states provided the sustained level of funding needed to serve patients with pre-existing conditions prior to the current law, and most imposing waiting periods, benefits caps, higher premiums and other restrictions designed to keep patients out of the insurance market.

ACS CAN opposed the AHCA and urged House members to vote “no” on behalf of the cancer community. Provisions contained in the bill that led the CBO to conclude that 14 million people would lose coverage next year, including the elimination of the Medicaid expansion, will now be debated in the U.S. Senate, and AHCA is unlikely to survive that experience in its current form.  A vote could happen in the U.S. Senate before the end of June.

ACS CAN have regularly noted that the current law has weaknesses and needs improvement. During the House debate, we have tried to work with lawmakers to identify ways to make the law work better for cancer patients – as have the American Medical Association, other patient groups, hospitals, and insurers.  ACS CAN is working closely with members of the Senate and our partners to craft legislation that helps improve the law and guarantees uninterrupted and meaningful health insurance coverage for cancer patients. 

Our grassroots engagement and media advocacy efforts were extraordinary and played a remarkable role in shaping the public debate, even now, when our opposition was noted the time and again in the media and by legislators. Patient stories, town halls, public rallies, customized messages on social media, patch-through calls, drop-in visits with members’ offices – each of these efforts amplified the patient’s voice.  And our #KeepUsCovered campaign logged more than 1.1 million impressions across all of Twitter and Instagram from our national Facebook page.

Cancer Research Funding

On May 23, the President introduced his proposed 2018 budget, which includes deep cuts to the National Institutes of Health (NIH), National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC) and Medicaid. If approved by Congress, the cuts would decrease the NIH budget by 21 percent, decrease the NCI budget by 21 percent, cut the CDC’s chronic disease program by nearly 20 percent and reduce Medicaid funding by more than $600 billion.

Cutting the NIH budget by $7.1 billion would seriously jeopardize the development of new, potentially life-saving cancer diagnostic tools, prevention methods and treatments. It would also risk eroding the basic scientific research that, when combined with private investment, spurs American medical innovation and economic development. Most specifically, the cuts would completely undermine the increases for research secured in the bipartisan 21^st Century Cures Act meant to accelerate progress against diseases like cancer.

A recent poll release showed an overwhelming 90 percent of voters believe federal funding for medical research is ‘very’ or ‘extremely’ important and 75 percent want Congress to significantly increase NIH funding. More than two-thirds oppose the cuts as proposed in the President’s budget.

Cancer research is on the verge of significant new breakthroughs that could help save lives from a disease that continues to kill more than 1,650 Americans each day. Just last week, the American Cancer Society released a report showing one in every five adult cancer diagnoses and two of every three childhood cancer diagnoses are considered rare. These patients and their families depend on the promise and progress of continued research investment to develop new therapies that will help to get and keep their specific diagnoses in check.  

In addition, cutting the CDC chronic disease budget by nearly 20 percent threatens to substantially weaken vital tobacco prevention and cessation programs as well as important efforts to address nutrition, physical activity, and obesity—all significant cancer risk factors.

The results of these cuts combined with the more than $600 billion reductions in Medicaid funding, could leave millions of Americans without access to meaningful health care and prevention services.

To date, the federal government has played a critical role in our ability to reduce the cancer burden. Such drastic budget reductions would have the potential to devastate the nation’s standing as the global leader in cutting-edge medical research and scientific discovery, hamper progress in detecting cancer early when it’s least expensive to treat and most survivable and severely restrict low-income patients’ access to critical safety-net health care coverage through Medicaid.

Moving forward, ACS CAN will continue to urge lawmakers to preserve their bipartisan commitment to research and prevention and reject these cuts when crafting the FY 2018 budget. 

Michigan Update

Appropriations

Numbers were released last month at the Consensus Revenue Estimating Conference that showed a deficit in Michigan’s state budget. The General Fund Revenues are down by a total of $392.7 million for three years.  We are now facing potential budget cuts. To fix this shortfall the House has proposed cutting funds for all prevention programs.  They’ve proposed cutting funds in half for the Cancer Prevention Program and Tobacco Prevention program.  There’s more support for maintaining funding levels for these critical programs in the State Senate.  ACS CAN is working hard to save our funding.  Final budget decisions are likely to be made by the end of June.

Healthy Food Access

Another area of appropriations that has been our focus is on Healthy Food Access. 

With the state budget, almost complete it appears we may make some gains in this area. 

This year’s budget will include additional funding for SNAP (Supplemental Nutrition Assistance Program) benefits which have been allowed to be used at farmer’s markets. Farmers markets are a great location to get fresh foods, but obstacles have persisted for SNAP benefits users. The new funding will allow for wireless devices to accept payments and funding to purchase those wireless devices for SNAP benefits.  The use of wired devices and the cost of wireless devices has become an obstacle for farmer’s markets to take SNAP benefits and many farmers don’t have the means to purchase expensive wireless devices. This funding will help remove that obstacle.

Additional funding for the 10 Cents a Meal program will be including in this year’s budget. The 10 Cents a Meal program in northern Michigan is providing schools 10 extra cents per child per meal to purchase fresh produce from local growers. The program only had funding for 16 schools to participate out of the 52 schools that applied.  Local farmers have the fresh fruits and vegetables that students need but are challenged to get it into the school systems. These additional funds will be used to continue and expand the pilot program to help schools get these fresh fruits and vegetables while helping local growers in the process. 

It looks like we will not be able to secure funds for our corner store initiative.  This initiative would have provided a one-time grant to corner stores and convenience stores to put in equipment that would make it easier to sell fresh fruits and vegetables in their stores.  These stores would be focused on areas in the state that do not have access to fresh fruits and vegetables and these stores are the only place that people

can get groceries.

Tobacco 21

Representative Tommy Brann (R-Walker) and Representative Abdullah Hammoud have introduced a package of bills that would prohibit the sale of tobacco products in Michigan to anyone under the age of 21.  Several states have already passed similar legislation.

Additionally, Genesee County is facing a legal challenge to their local tobacco 21 regulation.  The health organizations supporting the regulation believe that Genesee County is well within their legal means to pass and enforce a regulation of this type.  The plaintiffs are arguing that state law prohibits a local municipality from passing such a law.  ACS CAN will be submitting an amicus curiae brief along with many other health organizations including the Campaign for Tobacco Free Kids, American Heart Association, American Lung Association, and Trinity Health Systems to the court to defend the tobacco 21 regulation in Genesee County.  Amicus curiae is Latin for "friend of the court," meaning a person or group who is not a party to a lawsuit, but has a strong interest in the matter and seeks permission to submit a brief with the intent of influencing the court's decision.

Oral Chemotherapy Fairness

Oral chemotherapy fairness legislation will be introduced in the fall.  Negotiations between legislators and lobbying groups have delayed introduction.  There may be legislation introduced in both the House and the Senate this year.  ACS CAN will be focusing on House members and specifically members of the House Insurance Committee.  Throughout the summer, ACS CAN volunteers will be attending coffee hours and collecting postcards to send to State Representatives encouraging them to create oral chemotherapy fairness.

Take Aways:

·         Budgets are moving and money for tobacco and cancer prevention programs are at the threat of being cut in half.

·         Funding for healthy food initiatives have made their way in the budget and could stay.

·         Tobacco 21 legislation has been introduced in the State House to prohibit the sale of tobacco products to anyone under the age of 21 throughout Michigan.

·         Oral Chemotherapy Fairness legislation is expected to be introduced this fall and our focus will be with members of the Michigan House of Representatives.

Notebook Page 25, April 2017

The legislature continues in its budgetary work with the both chamber Appropriations committees starting to finalize their first round of budgets. The income tax reduction continues to linger on in the House, leaving members on the Appropriations trying to cut back on the budget so that the money will be available for those who want to cut taxes. Let's review major activity in the House and Senate over the past few weeks.

Appropriations committees took their first stabs at putting together a budget for the coming fiscal year. ACS CAN have been active in the appropriations in three major areas this go around. The usual tobacco and cancer prevention funding dollars continues to stay as a top priority for ACS CAN. Funding for the programs has seen a stabilization over the past couple cycles due to a great amount of advocacy work done by those all-around Michigan. This year both chairmen of the Health and Human Services budget indicated that there would be no change in the funding levels for the tobacco and cancer prevention programs in the first go around. We will continue to monitor the situation as the bills move forward in the process.

Our second activity in the budget surrounds healthy food access. There were three asks in the budget this year that ACS CAN worked on with coalition partners. The first was providing a one tine grant to corner stores and convenience stores to put in equipment that would make it easier to sell fresh fruits and vegetables in their stores. We know there are areas in the state that do not have access to fresh fruits and vegetables and these stores are the only place that people can get groceries. Our hope is with this funding we can grow the access to the needed food.

Farmers markets are a great location to get fresh foods. SNAP benefits in the past few years have been allowed to be used at farmer’s markets. One of the great programs around the SNAP program is one that allows for a doubling up for SNAP dollars for those buying food at farmer’s markets. One of the major hurdles is the way that SNAP benefits are taken. The market needs to have a hard-wired device to accept the payments. Many farmer’s markets don't have that luxury to allow for that so this leaves this option unavailable for those with SNAP. Wireless devices are available but they are costly and currently not required under contract with the SNAP vendor. ACS CAN is advocating for that to change. We are asking the legislature to change the contact to allow for wireless devices and make them available at all farmer’s markets in Michigan that want them. 

Finally, fresh fruits and vegetables have a hard time making into our children's lunches sometimes. Local farmers have the produce but have hard times making it into the school systems. That all changed with the 10 Cents a Meal program. This is a pilot program in northern Michigan that is providing schools 10 extra cents per child per meal to purchase fresh produces from local growers. ACS CAN supported the proposal last session and saw that 16 schools participated in the program with 52 applying. This year we are asking for a continuation of the pilot to help schools get the fresh fruits and veggies they need and help local growers in the process.

As you have likely heard in the news, the efforts to repeal and replace the Affordable Care Act are continuing.  The American Health Care Act (AHCA) is the replacement plan that has been debated. This bill would significantly alter the accessibility, adequacy and affordability of meaningful health insurance for millions of Americans, including those who have coverage through Medicaid. ACS CAN did not support this legislation when it was moving through the process back in March because it would undermine access to affordable, quality coverage, and put patient protections at risk.  The bill would significantly reduce the number of Americans able to access and afford quality health insurance.

Unfortunately, the bill has been amended and is now even worse for cancer patients.  An amendment has been added that would allow states who set up high-risk pools to waive the Essential Health Benefits, meaning that cancer patients would no longer be guaranteed coverage for chemotherapy, prevention, or hospitalization. While in theory plans would have to accept everyone, insurers could set up plans that don’t cover the services that people with chronic illnesses like cancer need, thus opening the door for backdoor discrimination.

The amendment would also allow patients with pre-existing conditions to be charged much more for their plans, and could price people out of the market. The bottom line is that it could make plans both worse and more expensive for cancer patients and survivors. Congressional leadership is trying to get the votes to pass this bill.  ACS CAN strongly opposes this bill as it is not a replacement that is better than the current system.

Take Aways:

·        Budgets are moving and money for tobacco and cancer prevention programs are safe for the moment

·        Funding for healthy food initiatives have made their way in the budget and could stay.

That activity has been front and center for us over the past month but I would also look for issues surround tobacco and oral chemotherapy fairness to make their way to the surface in May. If you have any further questions please don't hesitate to reach out to myself (andrew.schepers@cancer.org) or Matt Phelan (matt.phelan@cancer,org) with any questions. 

Notebook Page 24 March 2017

March came in like a lamb as far as the Michigan legislature is concerned but on the federal level, the roar of the health care lion was heard loud and clear nationwide. House Republicans in Congress said that the time was now to finally repeal the Affordable Care Act and replace it with the American Health Care Act. By the end of March would House Republicans have the ability to move the legislation across the finish line in the House, let's review March.

State:

In Michigan, the legislature continued crafting their policy legislation for the coming term. Many new members in the House were just starting to have their first bills introduced on the House floor, while the Senate will moving legislation as if nothing was new in their chamber. The House and Senate concentrated on their respective budgets by continuing and finalizing hearings. Earlier in the year, the House attempted to pass a cut to the state's income tax that would leave a $1.1 Billion hole in the State's budget. Now it appears that the House is looking to start making some of those cuts without cutting the income tax with reductions seen in most budgets that the House has passed already. The Health and Human Services budget hasn't been passed yet by the subcommittee and full appropriations committee as of yet. It is the largest budget in state government so it may take a week to finalize the budgetary numbers.

On the policy side, there is a large push with the introduction of several bills that would control the availability, accessibility, and the clinical use of opioids. Pain management is a part of palliative care and ensuring that patients have access to quality palliative care continues to be a top priority for ACS CAN. We will be working with the legislature, policy makers, and those groups working to ensure that quality access continues to be at the forefront of the discussion. Our legislation around oral chemotherapy fairness and tobacco taxes should be finished and ready for introduction by the end of April.

Federal:

On March 24, the U.S. House of Representatives failed to vote on the American Health Care Act (AHCA). This bill would have significantly altered the accessibility, adequacy, and affordability of meaningful health insurance for millions of Americans, including those who have coverage through Medicaid. ACS CAN does not support this legislation because it would undermine access to affordable, quality coverage, and put patient protections at risk.

The bill would significantly reduce the number of Americans able to access and afford quality health insurance. According to an initial report on the legislation by the Congressional Budget Office, 15 million more Americans would have been uninsured by next year and 52 million Americans would be uninsured by 2026—24 million more than under current law. This includes millions of low-income Americans who, because of significant Medicaid funding cuts, a reduction in the premium tax credit and expanded age-rating, would be priced out of the health insurance market. Many of these same Americans also have higher risk factors for cancer.

In the end, House Speaker Paul Ryan, his leadership team, and the Administration decided to pull the vote on Repeal & Replace of the Affordable Care Act since they could not secure the necessary votes to pass the legislation.  Although the current law is not perfect it is critical for so many as it relates to our cancer mission.

The President recently introduced a proposed the fiscal year 2018 budget that includes deep cuts to medical research. If approved by Congress, the cuts would represent 19 percent of the National Institutes of Health’s (NIH) total budget and would likely result in a $1 billion cut to the National Cancer Institute (NCI).

The proposed reduction in NIH funding of $5.8 billion would represent a significant setback for millions of American cancer patients, survivors, and their families. It would also dramatically constrain the prospect for breakthrough American medical innovation—an essential American economic driver.

If enacted, the budget proposal would likely result in a nearly $1 billion decrease for cancer research at NCI—making it the largest funding reduction in its history. The cuts would set research funding back to the level it was in 2000 when accounting for inflation.

In December, Congress passed the 21st Century Cures Act. This bill represented lawmakers' overwhelming bipartisan commitment to the promise and necessity of medical research to our country's future.  The legislation included $4.8 billion in new funding for the NIH, including $1.8 billion for the National Cancer Moonshot Initiative. This legislation provided substantial new investment in research and will lead to new ways to prevent, detect and treat cancer and other serious diseases.  The proposed cuts that have been introduced will erase all of that.

NIH-funded medical research is conducted in thousands of labs and universities across the country. These grants in turn spawn increased private investment and development. Drastically reducing NIH's budget would jeopardize our nation's potential to save more lives while simultaneously risking America's position as the global leader in medical research.

Michigan Day at the Capitol:

ACS CAN advocates were very active around this issue and the hard work showed as key members of Congress backed away from their initial support for the legislation.  Our work on the Affordable Care Act is not over and ACS CAN will remain diligent in our efforts to ensure that health care is adequate and affordable for everyone.

Registration for Michigan’s Day at the Capitol (formerly called Lobby Day) has been open for just about a month now.  The Day at the Capitol will be on Wednesday, May 3rd.  Registration will close on April 21st.  This year, we’ll be holding our event at the Radisson Hotel in downtown Lansing.  The agenda for the day will be similar to previous years with some small changes.  The URL below will take you to the registration site.

www.acscan.org/milobbyday 

Any ACS volunteer is welcome to attend, but please let ACS CAN staff know prior to inviting anyone to ensure we are getting the right volunteers. We are looking for volunteers that are motivated to make a difference in the fight against cancer, are passionate about our mission, and are willing to share their cancer story.  Volunteers do not need to be advocacy volunteers or have any experience advocating. Appointments with lawmakers will be scheduled for all volunteers that attend.  

Our Day at the Capitol will focus on three important issues this year:
·        The need to increase tobacco taxes to curb youth tobacco use and provide much-needed funding for Michigan’s prevention programs, which have been drastically cut over the past decade, to provide cancer services and tobacco prevention to Michigan residents that need it the most.
·        Increase access to cancer drugs through Oral Chemotherapy fairness.
·        Create a roadmap for the future of Palliative Care in Michigan

If you have any questions about Michigan's Day at the Capitol or any other questions, please contact Matt Phelan (matt.phelan@cancer.org) or Andrew Schepers (andrew.schepers@cancer.org)

Take Aways:

• No changes planned at this point for tobacco and cancer prevention funding levels in the budget.
• Legislation to limit the ability to prescribe and use opioids has been introduced and could affect cancer patients and their pain management.
• Register for Michigan's Day at the Capitol at www.acscan.org/milobbyday

Notebook Page 23 February 2017

Budgets and taxes continue to dominate the activity of the Michigan legislature during February. The Governor presented his budget to the legislation early in the month which provides some positive points for patients around Michigan. Governor Snyder continued to show support for the Healthy Michigan Plan, Michigan’s Medicaid expansion. Also included in the budget was a continuation of the funding for the cancer and tobacco prevention programs. Those continue to stay at their current funding levels for the coming year. Now the House and Senate will continue to review the proposal and take testimony from groups around the state on the different issues included in the budget.

On February, ACS CAN along with AHA and ALA hosted a welcoming reception for the members of the 99^th legislature. This provided a great opportunity to meet some of the new lawmakers and talk to those seasoned veterans of the legislature on the major issues facing the groups this year. Attendance for the first time a was a little space, but it isn’t due to the issues of our three groups but rather taxes.

The same night the House decided to take a vote in passing a roll back of Michigan’s income tax. The current rate is at 4.25% and when that was raised there was a promise from the legislature that a rollback would happen over several years to 3.9%. The state still continued to need the money being generated from the increase so a couple years after the raise, the legislature went in and made the raise permanent.

House Republicans this year felt that this was the year that the state needed to make good on the promise of a rollback and so they pushed through legislation to do just that. What would a rollback mean, it would create a hole in the state budget to the tune of $1.1 Billion. This is a major concern is that with the declining funds major programs that we are supportive of like programs above would be cut or eliminated.

The members of the House spent over 12 hours in the House chamber trying to get enough support to have the measure pass, but at the end of the day, it failed by three votes. Now the House will continue to work the issue and can ask for the vote to be reconsidered, so this issue isn’t over yet and we will continue to monitor the activity around this issue.

Registration for Michigan’s Day at the Capitol (formerly called Lobby Day) is now open.  The Day at the Capitol will be on Wednesday, May 3^rd.  Registration will close on April 21st.  This year, we’ll be holding our event at the Radisson Hotel in downtown Lansing.  The agenda for the day will be similar as previous years with some small changes.  The urn below will take you to the registration site. 

www.acscan.org/milobbyday 

Any ACS volunteer is welcome to attend, but please let ACS CAN staff know prior to inviting anyone to ensure we are getting the right volunteers. We are looking for volunteers that are motivated to make a difference in the fight against cancer, are passionate about our mission, and are willing to share their cancer story.  Volunteers do not need to be advocacy volunteers or have any experience advocating. Appointments with lawmakers will be scheduled for all volunteers that attend.   

Our Day at the Capitol will focus on three important issues this year: 

·        The need to increase tobacco taxes to curb youth tobacco use and provide much needed funding for Michigan’s prevention programs, which have been drastically cut over the past decade, to provide cancer services and tobacco prevention to Michigan residents that need it the most. 

·        Increase access to cancer drugs through Oral Chemotherapy fairness. 

·        Create a road map for the future of Palliative Care in Michigan 

If you have any questions about Michigan's Day at the Capitol, please contact Matt Phelan. 

Our ACS CAN ACT Leads and Ambassadors are completing “Drop Bys” to their members of congress with our federal #KeepUsCovered campaign to address the ongoing debate around the Affordable Care Act.  Volunteers will continue to contact members of Congress to discuss the issue of adequate and affordable healthcare for all cancer patients and survivors. 

As always, if you have any questions please don’t hesitate to contact Matt (matt.phelan@cancer.org) or myself (Andrew.schepers@cancer.org) with any of your questions.

Take Aways:

·        Budget work continues with no impending cuts to tobacco and cancer prevention programs and shows Healthy Michigan.

·        House fails to pass income tax rollback. This would have drastic impacts on the state, creating $1.1 Billion hole.

Notebook Page 22 January 2017

The Michigan legislature is finally back in full swing and the Governor provided his annual state of the state address, providing a report card on how Michigan is doing. The new session means a new year for ACS CAN as well and the start of a new educational process with over 40 new lawmakers in the House of Representatives.

Governor Snyder’s State of the State speech to most pundits didn’t move mountains. The speech really provided a report card on how Michigan is doing. Health wise there were not many mentions of major health initiatives except for the efforts in Flint and Healthy Michigan. At last count, Michigan has over 640,000 people on the Healthy Michigan Plan, which is being touted as one of the models of how Medicaid expansion can work in all states. Over the next several months, while discussions are happening around the Affordable Care Act, Governor Snyder will continue to deliver his message that Healthy Michigan is the right direction for the country.

ACS CAN will continue to support the Healthy Michigan Plan and educate lawmakers on why it’s important to continue to offer in Michigan. Along with that, we will be educating on our major campaigns for the year. This year ACS CAN is working on issues surrounding Palliative Care, Tobacco Taxes, Oral Chemotherapy Fairness, and others.

Our efforts surrounding Palliative Care are built off of the report that ACS CAN and partners from ACS and other health groups from around the state put together that outline some of the major hurdles surrounding Palliative Care. One of the major asks in the report is the creation of a Palliative Care Commission on a state level that will look at the palliative care and provide actionable items to the Legislature to better our palliative care systems. We are working with Governor Snyder to create this commission through executive order rather than make it statutorily. Our goal is to have this ready to go by summer 2017.

Tobacco taxes will again be a major campaign for us this year. Michigan currently falls into the bottom third of the country in terms of tobacco prevention funding. Youth are shifting away from traditional tobacco and moving towards new emerging products and the state continues to face future financial issues in it’s Medicaid program. All of those issues and others leads us to ask for an increase in the cigarette tax by $1.50, create parity for other tobacco products, and regulate and tax e-cigarettes as tobacco products. This will provide substantial ongoing revenue for the state to help fund prevention and Medicaid issues.

Finally, Oral Chemotherapy Fairness is back again. I know all of the hard work that all of you did to help us move this issue over the finish line last time but we fall short due to politics rather than common sense. This time around we is fearful that our sponsor last term will be willing to cave to any of the demands from the health insurers, which could potentially leave us on the other side of the issue fighting against the legislation since it would do harm to patients than good. We will continue to keep engaged throughout the process to work and engaged with your volunteers and accounts to fight to greater access to these needed drugs.

On January 28 ACS CAN hold their annual Michigan volunteer training at Michigan State University.  Volunteers from all over the state attended and learned about ACS CAN’s state and federal priorities for 2017.  The top priority at this time is guaranteeing that any replacement for the Affordable Care Act includes the same or better protections for cancer patients.

ACS CAN will focus on four areas, or what we call our four A’s, for any Affordable Care Act replacement.  These are the four areas:

Availability

·         No pre-existing medical condition restrictions

·         Plans are prohibited from rescinding or canceling coverage when someone gets sick except in instances of fraud or misrepresentation

·         Availability and renewability of coverage is guaranteed

Affordability

·         Plans are only able to charge more or less in premiums based on family structure, geography, the generosity of the benefit, age (limited to a ratio of 3 to 1), and tobacco use (limited to a ratio of 1.5 to 1)

·         Plans cannot charge higher premiums because an individual has had a cancer diagnosis

·         Plans can charge older Americans no more than 3 times what they charge younger persons. This keeps health insurance more affordable for older Americans

·         Refundable tax credits provide premium assistance for individuals and families up to 400 percent of the federal poverty level for coverage in a marketplace plan

·         Out-of-pocket spending maximums for individuals and families

Adequacy

·         No lifetime and annual coverage limits

·         Coverage of preventive health services with no cost sharing

·         Requires all plans to provide a minimum level of benefits. Plans offered in the small group and individual markets have additional requirements to provide coverage of 10 categories of essential health benefits.

·         Requires plans to spend at least 80 percent of premiums on healthcare and quality improvement

Administrative Simplicity

·         Standardized summary plan documents that make it easier for consumers to compare plans when shopping

·         Insurance companies are required to streamline insurance appeals process to provide consumers with information about their appeals and the opportunity for external appeals

·         Plan navigators and other health insurance enrollment specialists help consumers apply for and understand coverage in the marketplaces and Medicaid

As always, if you have any questions please don’t hesitate to contact Matt (matt.phelan@cancer.org) or myself (Andrew.schepers@cancer.org) with any of your questions. Thanks again and remember pitchers and catchers start reporting on February 14^th!

Notebook Page 21, December 2016

Snow and the coming holidays didn't keep the legislature away from finalizing the work of Michigan’s 98th legislature. Two major issues that ACS CAN was working on surrounded access to drugs; regulations for biosimilar drugs and oral chemotherapy fairness. Both issues at the start of December seemed to have some life but would they be able to make it across the finish line.

Earlier in the year House Bill 4812, the bill that provides the needed regulations for the substitution and dispensing of biosimilar drugs in Michigan took a major turn for the worse in the Senate Health Policy committee just before the summer recess. Groups in favor of the legislation, as it came out of the House, were found scrambling and trying to find ways to amend the legislation back to the version that had passed the House and included the critical language that required notification to physicians of substitution. The Fall brought very little activity around the legislation but rather conversations with Senators about a possible amendment on the Senate floor back to the House version and then passage during the end of the year.

Amendments were drafted and a key Senator was named as a champion for the amendment. Lame duck started; the time in the legislature when at segments all right and reason seem to escape people and deals begin to develop to get legislation moving and passed before the end of the session. This legislation was no different and rather than having productive discussions around the legislation the opposite happened. Discussions by groups with Senators about the amendment started a destructive movement against the legislation. Finally, the chairman of the Senate Health Policy committee said enough was enough and the legislation was dead for the year, leaving groups that had worked on the legislation at the doorstep with nowhere to go and lawmakers frustrated over the issue.

We have documented throughout the year that oral chemotherapy fairness was a key issue for ACS CAN. In May of this past year, the Michigan Senate passed Senate Bill 625 with all but one vote. The legislation had huge bipartisan support in the Senate, which usually sends a message to those working in or with the legislature that it should have the same support in the House. We learned this term that the House and Senate, although controlled by the same party, were the furthest philosophically from each other then they have been in years. Several large key issues made their way from the Senate with worked out compromises, only to have the House completely tear it up and write their own deals. 

Oral fairness was no different. The Senate worked hard with all of the stakeholders to ensure that the legislation that would move was a compromise. Groups like ACS CAN and the Leukemia and Lymphoma Society (LLS) took some concessions but so did groups like Blue Cross / Blue Shield (BC/BS) and the Michigan Association of Health Plans (MAHP) The legislation was finally in a place that it had never been, where the major health plan in Michigan (BC/BS) was not supportive but would not stand in the way of it moving through the legislature and patient groups were in support. Then the wall appeared in the House and MAHP worked with the House leadership to have the legislation sent to a committee that shuttered at the slight notion of anything that is a "mandate". Just the slightest notion of having a prescribed function in the legislation left the committee wanting to know more, slowing down the process considerably.

Summer came and went with ACS CAN volunteers spending time in local coffee shops, on their phones calling into their lawmaker's office, sending quick e-mails to their lawmakers asking for support, and even dusting off stationary and pen sets to send the hand written letters. Lawmakers knew what oral chemotherapy fairness was by the end of the Summer, leaving now just action from the committee. No hearings came and lawmakers came and went, off to finish their campaigns. So ACS CAN ran a campaign of our own.

Volunteers all around Michigan took a poster to bring around to their activities having people sign them to show their support for oral fairness. A mobile petition you could say; twenty posters were created. After Thanksgiving, we received eighteen posters back and started to put a plan in motion to make a final run at getting oral fairness passed. The first full week in December ACS CAN hosted a two-day drop in lobby day where we took volunteers to the House chamber doors and sent in notes for their lawmakers to come out and discuss oral fairness. This started on a Tuesday morning and by the afternoon of that Tuesday, the answers from lawmakers were becoming consistent, oral fairness will not move without drug price transparency. We knew that lawmakers were talking with each other about the issue, which raised its visibility and caught the attention of the Capitol news corp. We also brought those posters to the Capitol and displayed them for everyone to see. The posters and our activities were noticed by the media and were featured in two news stories and several interviews on radio and television.

Tuesday night our coalition created an amendment to counter the problem that the price transparency ask was attempting to address. Volunteers continued to come on Wednesday and continued to talk about the issue with their lawmakers and included that ACS CAN and others had an amendment to solve the problem that price transparency was addressing. Lawmakers took that information back to their colleagues, but still, the House leadership was convinced that the need for transparency was too great.  Thursday came and went and lead us into the last week of the session. The first day of the last week was Tuesday and leadership was still not willing to move, which left us dead in the water, having to wait until next term to finally get the fairness patients deserve. 

Throughout that second to last week of the 98th session, we had over twenty volunteers make the drive to Lansing to discuss oral fairness with just a couple weeks notice. We had over 250 calls go into the Speaker of the House's office asking for action. We had amendments to solve problems, we had over 2000 signatures from people all around Michigan, several hundred emails were sent from volunteers, but MAHP won the day. MAHP did find out though that the patient groups are a passionate force and will win this battle one day.

As we move forward in 2017, we just want to say thank you for all of your efforts in 2016. We won't let those efforts go to waste and use them to build on a great 2017. As always if you have any questions please contact Andrew (andrew.schepers@cancer.org) and Matt (matt.phelan@cancer.org) and Happy New Year!